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Organization
HERITAGE VALLEY MEDICAL GROUP, INC.
Active
Organization
HERITAGE VALLEY MEDICAL GROUP, INC.
Active
Other names
Heritage Valley Convenient Care
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAN F MITRY (PRESIDENT & CEO)
(724) 773-4776
Entity
Organization
Contact information
Practice address
271 STATE ROUTE 288, ELLWOOD CITY, PA 16117-3055
(724) 773-4681
Mailing address
271 STATE ROUTE 288, ELLWOOD CITY, PA 16117-3055
(724) 773-4681
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015654460023
—
PA
Enumeration date
02/18/2016
Last updated
02/18/2016
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